Clinical and laboratory results are presented of 229 patients treated by highly selective vagotomy for duodenal ulcer in a non-university teaching hospital. Sixty-two per cent of the operations were performed by residents as part of their training. After 1-8 years follow-up (97 per cent complete) there were 22 recurrences (9.6 per cent). The residents had fewer recurrences than the consultants, but their patients follow-up was shorter. The usual Visick grading is presented (1, 2: 83.5 per cent; 3, 4: 16.5 per cent) as well as an additional way of grading described by Visick in 1948 which suggests that 4 per cent appear to be permanent failures. Mortality rate was 0.4 per cent, complications rate was low and side effects were in general of minor importance. Laboratory results are presented showing that the basal acid output (BAO) was reduced permanently by 65 per cent, and the PAO by 50 per cent. In patients with recurrences BAO was not reduced and the PAO was less reduced than in the non-recurrence group. Metabolic parameters did not deteriorate. Basal serum gastrin rose after operation while serum vitamin B12 remained constant with a minimal tendency to decrease.

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Several ways of analyzing recurrence figures are presented in order to demonstrate the difficult interpretation of recurrence rate with highly selective vagotomy (HSV) in 262 patients operated on for duodenal ulcer with an almost complete follow-up. Actuarial recurrence risks and cumulative recurrence hazards are calculated and compared with several studies on the same subject.We conclude that: (a) There is no such entity as a fixed or definitive recurrence percentage (usually indicated in clinical reports as "recurrence rate") after HSV or other operations for duodenal ulcer; (b) The risk of any patient developing a recurrence at any time after HSV is constant in the immediate future and is as high 6 years after operation as it is after 1 year; and (c) There is no permanent cure after HSV; cure can only be expressed as a certain probability of freedom from recurrence in a similar way to that of oncological or vascular surgery.

A continuous way of assessing the results after highly selective vagotomy (HSV) is presented, as applied in 262 patients operated on for duodenal ulcer. Regrading of ail patients who showed recurrences at any time is permitted according to their actual condition at each grading moment. The dynamic Visick grading shows the saine percentage of success at each assessment in spite of an ever increasing percentage of recurrences-many defined failures appear to be temporary failures--which is accounted for in this type of presentation.The conclusion is that HSV appears to favorably change the natural history of duodenal ulcer disease in 94% of patients at any time of assessment and that 3% of patients in the present series are graded as permanent failures.

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